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Home My WebLink Aboutwell info p WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I County Name WELL AND BORING SEALING RECORD Mennle oNa Unique Well No. � Minnesota Statutes,Chapter f031 or W-series No. (Loaw denk M nal lapwii) y Township Name Township No. Range No. Section No. Fraction(sm->Ig) Date Sealed Date Weli or Boring Conslructed G�rOnd 117 23 �7 3�-��t0$'" _ /r�: Lati[ude de rees minutes seconds GOCATION: 9 Depth Betore Sealing � ��--k. Original Depth ' J ft. Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ingle Aquifer ..Mul�aqurfer WELUBORING - [�Measured ❑Estlmated ater Supply Well ❑Monit.Well Show exact location of well or boring �Sketch map o well or ring � Env.Bore Hole Other � -� ft. [�below ❑above land suAace in section grid wfth"X" I ation,showing property ❑ ❑ lin s,roads,and buildings. � N 7 CASING TYPE(S) d% �� 't, ❑Steel �'lastic ❑Tile ❑Other ,. W —h- - -- -=-- --=-- E / WELLHEAD COMPLETION � � � - Outside: ❑Well House Inside: ❑Basement Offset _Y_ ____ _l__ __�__ � !}mib ��' j �,'Pitless AdaptedUnit ❑Well PR --�- -�-- -i-- --�-- I � �. ' ' ' ' � ❑Well Pit ❑Buried �, �—�^"w—� . '\ � ❑Buried PROPERTY OWNER'S NAME/COMPANY NAME ��, CASING(S) � � � Diameter Depth Set in oversize hole? Annular space initially grouted? PropeAy owner's mailing address'rf different than well location address indicated above � . in.from �to �� ft. ❑Yes �(No ❑Yes ❑No ❑Unknown �420 Shareline Dr � Sprin�r C�rR � �'�� .7�7pq �n.ffOm t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.f�om t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown � WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE Well owner's mailing address if ditterent than property owner's address indicated above SCf@0f1 ffORl � t0 �� ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑Check Valve(s) ❑ Debris ❑ Fill �IVo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YBS ❑ NO Describe FORMATION If not known,indicate estimated formation log from nearby well or boring PUMP , �„ - TYPe '"� = � ❑ Removed C�Not Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: (�fJo Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing PeAoration/Removal in.from to ft. ❑ Perforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Matenal � ��fienf` to ` ft. yards � bags i� from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on propeAy? ❑ Yes ❑ No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Cnapter 4725.The infortnation contained in[his report is true to the best of my knowledge. z�an �tc�dot At wet � n�3 � lix��Cc�-. I�c.. 2.7� 72 Contractor Business Name -. �nse or Registrahon�o. __ ,: .__..___ ' /' �-` !�-...�' �- � ho d res tat e Signatu Date ' � ��+� � ._,. ,. ,,._. .,.'-ti H __� _ , LOCAL COPY Name of Person Sealing Well or Borirrg � � t �"b WELL LOCATION MINNESOTA DEPARTMENT OF HEALTH MINNESOTA UNIQUE WELL NO. CountyName � � WELL QND BORING RECORD ,, Minnesota Stafutes, Chapter 103I � � ��, �� Township Name Township No. Range No. :' Section No. Fraction WELL DEPTH(completed) Date Work Completed 7 �� 297 � 2-16-t� GPS ` DRILLING METHOD LOCATION: Latitude degrees minutes seconds Longitude degrees minutes seconds `i Cable Tool ��Driven '__�Dug ❑Auger [�''Rotary --.Jetted House Number,Street Name,Ciry,and Zip Code of Well Location or Fire Number � DRILLING FLUID WELL HYDROFRACTURED? !—J Yes �No Show exact location of well in section grid with"X". ketch map of well location. �. i e FROM ft.TO ft. Showing property lines, roads and buildin s USE � N 9 ❑Monitoring Heating/Cooling 'J ,� � � � , � �Domestic ❑Emiron.Bore Hole �Industry/Commercial i . .--- ' `- ---`-- �, j j ; ; S ❑Irrgation emedial / . �� Noncommunity PW i J R ' ; ; � � � � � ❑Community PWS ❑Dewatering '�; --'-----�-- --�-- ---'-- i / � CASING HOLE DIAM. w ; ; ; � e � '* Drive Shoe? ❑Yes �lo , � � . , T = -,s _ - :� � _;-----;----_�---_,-- / teel � h eaded � elded J� t ��T • ��W , , , , '/z Mile StiC / i CASING� la ❑ .ry --'--- --�------'-----'- 1 , DIAMETER WEIGHT �' � g � � �^� ' f .`� � . / _�I�in.to j$5 ft. Z.O� Ibg,/R �in.to�[. �1 Mile—� � � / . . in.to ft. _ Ibs./fl. �in.to_��t. �� PROPERTY OWNER'S NAME/COMPANY NAME r., in.to ft. IbsJft. in.to ft. SCREEN OPEN HOLE Properbj owner's mailing address if ifferent than well location address indicated above. Make a�� FROM ft. TO ft. �i2O .�[FVL�i1TK DC TYPe --�IiII1TITas–atT—Diam.� ►S`ri �BrR �s ��p+} SIoVGauze___•� Length� � � � Set between ft.and it. FITTINGS STATIC WATE L EL +. s }.' .J .� t�i.�_ r LI�+� �� ft.� elow , ��above land surface Date measured � �� PUMPING LEVEL(below land surface) t WEIL OWNER'S NAME/COMPANY NAME 1� fl.after �� hrs.pumping � g.p.m. `�- WELL HEAD COMPLETION :� � , v� Well owner's mailing address if differeN than property owners address indicated abeve. �Pitless adapter manutacturer._L��-�....��-�L>�__!--.�*x�l Casing Protection �4A�in.above grade ��a ❑At-grade(Environmental Wells and Boring ONLY) GROUTING INFORMATION Well grouted �Yes ❑No Grout material [�Neat cement ❑Bentonite �_1 Concrete,�iigh Solids Bentonite - from__�to�_k. �_ �.��yds. �ags from_�a to��__ft. ��.�� [�, c��-'bags GEOLOGICAL MATERIALS COLOR HARDNESS OF FROM TO from to ft. _,yds. ]bags MATERIAL NEAREST KNOWN SOURCE OF CONTAMINATION � e �+, .i- .. . f�� feet __ ��__ direction ', �ti�--�-.• -.� ]� .r– tupe .-� i � Well disinfected upon completion � es ❑Na �-„►... PUMP � ;Not installed Date installed ��l �� '"� - '.i`�' Manufacturer's name �lh.�.✓._,,,i�, �, �'•�'C`-�.. ;s � / . Model number � � HP_L[�,�Volts • ..��" � �� Length of drop pipe f�,,,/." ft. Capacity g.p.m. Type: ubmersible ❑LS.Turbine ❑Reciprocating ❑Jet ;] - . ABA ONED WELLS Does property have any not in use and not sealed well(s) ��,]Yes j�Jo VARIANCE Was a variance granted from the MDH for this well? �]Yes o TN# WELI CONTRACTOR CERTIFICATION This well was drilled under my supervision and in accordance with Minnesota Rules,Chapter 4725. The information contained in this report is true to the best of my knowledge. Use a second sheet,if needed REMARKS,ELEVATION,SOURCE OF DATA,etc. Licensee Business Name �� Lic.or Reg.No. _ ��/V `� o ed e r� t ve$ig� ure Date � -- Gtntck I�oce ; ' LOCAL COPY � '? � j � ^.� Name ofOriller �::_ J � J HE-01205-08(Rev.5/02) - IC 140-0020 � � �t - ' rw�. c�y w�� c � � , .�� 617 13th Ave So • Hopkins, Minnesota 55343 • (612) 935 - 3556 02/20/2006 Stodola Well DriJling � 384) North Main Sr. Bonifacius MN 55375 938-2 l 11 REPORT OF WATER ANALYSIS Lab#: 86BN Our Laborarory reports these analyrical resulis, deiermined on a sample taken by CLIENT on 02/16/2006 from rhe following location: 4203 North Shore Dr. Orono,Mn Well#735713 Coli form Bacreria <1/100 mi Nirrares Nirrogen <1,0 mg/) The resulis of these tests indicare that this well is producing wat�er that meeCs the standards for F.H.A., V.A., or convenrional loans. This report is an analysis for coliform and nitrate only and do�s not indude analysis of Lead and arher contaminunts. (Unless as specified by client). •,Twin City Water Clinic, lnc. .�\� `,,\ \`,,. Bill` • r��4rsdale � �� i,nb C'ettificntion J1 0271153-1 1 9 � , ._ _ _ _ ,: _ _ , � WELL OR BORING LOCATtON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„' Counry Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. - �� i� Minnesota Statutes,Chapter 1031 or W-series No. (�eeve denk n na wwww�,) Township Name Township No. Range No. Sectio�No. Fraction(sm-i Ig) Date Sealed Date Weli or Boring Canstructed t?rt)[!O 117 23 �7 �% �,. �,. ��. " L GPS ��de degrees minutes seconds � LOCATION: Depth Betore Sealing �� ft. Original Depth ft. Longitude degrees minutes seconds ppUIPER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and Ciry of Well or Boring Location ingle Aquifer ❑Multiaquifer � C � WELUBORING Measured ❑Estimated � � `GYWater Supply Well ❑Monit.Well Show exact location of well or boring map of well or boring l� �';°'"r�> ° `/ in section grid with"X" on,showing property ❑Env.Bore Hole ❑Other _`- �• ry. f7�elow ❑above land suAace lin `o�s,•and buildings. r� N �A CASING TYPE(S) =� I I � � ��'� �l; ❑Steei lastic ❑Tile ❑Other ' � , , � • �"� W --�- -�-- -;-- --�— E /�� / �� WELLHEADCOMPLE110N , � , � � _____. � � � � � � �/ /� �Outside• ❑Well House Inside: ❑Basement Oifset --�- -:- -;-- --a-- / \ -.__.�.❑ a ❑ `� ' ' ' ' �� PiUess Ada tedUnit Well Pit ��. --�- -�-- -�-- --�— I j� � � � � �- ❑Well Pit ❑Buned S �'—�'"'�°—�" ❑Buried J�xT io r �� PROPERTY OWNER'S NAMEJCOMPANY NA�ME�q� CASING(S) �C�� +�d Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above /f / t � m.f�om1�_ t0�ft. ❑Yes �o ❑Yes ❑No ❑Unknown 4420 Shoecline 1)t c.� �� S�� L„1�' � t�T�3� in.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown R J � .�.' � ir1.from t0 ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown �� WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE � f Well owner's mailing address if diNerent than property owners address indicated above Screen from��t0�Q_ft. Open Hole from t0 ft. OBSTRUCTIONS r ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �o Obstruction Type of Obstructions(Describe) r GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YBS ❑ NO Describe FORMATION If not known,indicate estimated fortnation log from nearby well or boring PUMP Type ❑ Removed ot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: (�Jo Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Perloration/Removal in.from to ft. ❑ Perforated � Removed in.from to ft. ❑ Pertorated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=941bs.,one bag of bentonite=50 Ibs.) j / / � Grouting Material�R(�,�� /��d/��from_�L to L�ft. yards �_ bags from to R. yards bags from to ft. yards bags OTHER WELLS AND BORINGS �� REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The infortnation contained in this report is true to the best of my knowledge. non �tvdola �1e11 Dri2iin� Ca,. Inc. � %>/ Contractor Business ame License or Registration No. � -- iT�� „;?':� -�" p':. 9. � A d epresentatrv Signature Date ' LOCALCOPY H 4g�as �� r� Name of Person Sealing Well or Boring � ! WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring '„I County Name WELL AND BORING SEALING RECORD MinnlesoNa Unique Well No. �il[lepiEl Minnesota Statutes,Chapter f03/ or W-series No. ��ee�e om�+�a oa aw.n� Township Name Township No. Range No. Section No. Fraction(sm�Ig) Date Sealed Date Well or Boring Constnicted Orana 117 23 07 ,. ,. ,. — ,�,� ,�j GPS ��de degrees minutes seconds � LOCATION: Depth Before Sealing �� tt. Original Depth ft. Longitude degrees minutes seconds q IFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location Bingle Aquifer ❑Multiaquifer itL�J3 � h Shc�re Dr ��'fJT1Q WELUBORING �Measured ❑Estimated �(�Vater Supply Well ❑Monit.Well � Show exad location of well or boring ke h map of well or bonng �,'".�"`-� in section grid with"X" ation,showing property ❑Env.Bore Hole ❑Other -r"" ft. �below ❑above land surface N �s,and buildings. � CASING TYPE(S) - - - - - -- -i-- �_ Y ; ,�,1^ u, ❑Steel �lastic ❑Tile ❑Other �Yo � W --�- - -- - -- --i-- E ��' � WELLHEAD COMPLETION f� utsidei'❑Well House Inside: ❑Basement Offset --�- -;— -;-- --i-- � �� / � _.._—� �� J ❑Pitless Adapter/Unit ❑Well Pit --;- -�-- -i-- --i-- I / � f ❑Well Pit ❑Buried S I ��""~�' ❑Buried f}(j ,� ��/�- PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diamet f E Depth , Set in oversize hole? Annular space initially grouted? Pro n a re' i t t ocation address indicated above 'L� � w.,�' � in.ffOm.�_ t0��ft. ❑Yes �rvo ❑Yes ❑No ❑Unknown T '�� i� � in.from to ft. ❑ves ❑No ❑ves ❑No ❑Unknown Sprin�; Park, t�+,' S53R� �, _ in.from to ft. ❑ves ❑No ❑ves ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE a / Well owner's mailing address if different ihan property owner's address indicated above Screen from�_�YO�ft. Open Hole from t0 ft. OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill �(�lo Obstruction Type of Obstructions(Describe) GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? ❑YBS ❑ NO Describe �� FORMATION If not known,indirate astimated formation log from nearby well or boring PUMP Type ❑ Removed ot Present ❑Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: No Annular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing Pertoration/Removal in.from to ft. ❑ P+erforated ❑ Removed in.from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonke=50 Ibs.) ,/�� / ��/�� Grouting Material 1/J`�'�'�[,,,f-��d-�rom�to��4dft. yards �bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑ Yes o How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The infortnation contained in this report is true to the best of my knowledge. dc� St�ala w�ell Drill.ic�; Co,. I�c. i691 Contractor Business Name License or Registrab'on No. , , �� /. w' � ,.,., r ff �/''�`�� Ef"'�.5�� .,��f �"-_ �_,. A�@ h�o�epresentative Signature Date LOCALCOPY H 249110 t� St�rner Name of Person Sealing Well or Boring